title: Cytomegalovirus (CMV) shedding is highly correlated with markers of immunosuppression in CMV-seropositive women.
abstract: Cytomegalovirus (CMV) enters latency following primary infection and can subsequently reactivate. Reinfection with a different viral strain can also occur. During these events, CMV is shed in bodily fluids. This study examined correlates of CMV shedding in specimens obtained from the HIV Epidemiology Research Study, a multicenter cohort study of US women with or at high risk for human immunodeficiency virus (HIV) infection. Among the women studied, 91.4 % (911/997) were CMV IgG seropositive. Of these women, 2.7 % (25/911) were CMV IgM seropositive. CMV DNA was detected via real-time PCR more frequently in cervicovaginal lavage (CVL) specimens (55/764, 7.2 %) than in peripheral blood mononuclear cells (PBMCs) (26/897, 2.9 %). CMV viral loads in 1 ml CVL (median 534; mean 2598; range = 40-74, 844) were higher than in 10⁶ PBMCs (median 264; mean 1287; range = 35-13 ,250). CMV DNA in PBMCs was associated with HIV seropositivity [odds ratio (OR) 13.5; 95 % confidence interval (CI) 1.8-100], increasing HIV viral load (P<0.001 for trend), decreasing CD4 cell counts (P<0.001 for trend) and CMV DNA in CVL (OR 26; 95 % CI 10.7-64). CMV DNA in CVL specimens was associated with CMV IgM seropositivity (OR 4.3; 95 % CI 1.5-12.3), HIV seropositivity (OR 7.3; 95 % CI 2.6-20), increasing HIV viral load (P<0.001 for trend) and decreasing CD4 cell counts (P<0.001 for trend). The positive predictive value of CMV IgM seropositivity for CMV DNA shedding in either PBMCs or CVL was 20 %. In summary, CMV shedding in CVL and PBMCs was highly correlated with each other and with markers of immune suppression.
authors.affiliation: Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Schoenfisch
authors.affiliation: National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Sheila C
authors.initials: SC
authors.lastname: Dollard
authors.affiliation: National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Minal
authors.initials: M
authors.lastname: Amin
authors.affiliation: National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Lytt I
authors.initials: LI
authors.lastname: Gardner
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Klein
authors.affiliation: Brown University School of Medicine, Providence, RI, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mayer
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Rompalo
authors.affiliation: Wayne State School of Medicine, Detroit, MI, USA.
authors.forename: Jack D
authors.initials: JD
authors.lastname: Sobel
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cannon
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D001769:Blood / Q000821:virology; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology*; D006801:Humans; D007108:Immune Tolerance; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007963:Leukocytes, Mononuclear / Q000821:virology; D008875:Middle Aged; D014481:United States; D014621:Vagina / Q000821:virology; D044364:Vaginal Douching; D019562:Viral Load; D017201:Virus Shedding; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M